Use of licap and ltap flaps for breast reconstruction.

Breast conserving surgery has been reserved for patients with favorable proportion between tumor dimensions and breast size. Introduction of local flaps from the lateral thoracic region has widened the indications for breast conserving surgery, by allowing surgeons to perform wider excisions, thus yet be able to ensure tumor-free surgical margins and a good aesthetic result. We have used lateral intercostal perforator flaps and flaps harvested on the lateral thoracic artery and lateral thoracic artery axial flap in patients with small breasts and an unfavorable tumor to breast size proportion. From May 2015 to October 2016, 19 patients with breast tumors have been treated with BCS and immediate volume replacement reconstruction by pedicle perforator flaps from the lateral thoracic region. In 15 patients lateral intercostal artery perforator flaps or lateral thoracic artery perforator flaps were used after quadrantectomy or wide local excision, in 3 patients as volume replacement after mastectomy and in 1 patient after mastectomy following previous augmentation mammoplasty. In all patients, good breast symmetry was achieved, with no major complications. Fibrosis of the flap and residual breast parenchyma, with volume reduction were noticed after postoperative radiotherapy in thin patients or flaps with little subcutaneous fat. Perforator flaps from the lateral thoracic region should become the gold standard for reconstructions after breast conserving surgery involving less than 20% of the breast volume or after mastectomy in patients with small breasts. The operating procedure is safe, quick and allows sparing of the latissimus dorsi muscle and thus minimal donor site morbidity, as well as an excellent aesthetic result.

PATIENT SATISFACTION AFTER BREAST RECONSTRUCTION: IMPLANTS VS. AUTOLOGOUS TISSUES.

INTRODUCTION: Breast reconstruction is increasingly present in the treatment of breast cancer. It may be accomplished with implants or autologous tissues. This cross-sectional study evaluates patients satisfaction and quality of life in women after successful autologous or implant breast reconstruction. MATERIAL AND METHODS: 109 women who successfully underwent breast reconstruction between 2007 and 2016 were included. The patients completed the BREAST-Q questionnaire at follow-up visits. Additional data were collected retrospectively from the hospital charts regarding complications, smoking, chemotherapy, radiotherapy, unilateral or bilateral reconstruction, BMI and comorbidities. Mann-Whitney U Test was applied to evaluate differences between the autologous breast reconstruction group (n = 50) and the implant breast reconstruction group (n = 59). RESULTS: Women with a successful autologous reconstruction were significantly more satisfied with their reconstructed breasts than women with successful alloplastic breast reconstruction as measured by the BREAST-Q breasts module (p = 0. 00596), psycho-social well-being module (p=0.04) and sexual well-being module (p=0.00068). Furthermore, there is a higher degree of satisfaction in patients who have not undergone radiotherapy, with no complications and with a normal BMI for implant reconstruction group as well as in non-smokers, and bilateral reconstructions for flap reconstruction group. DISCUSSION: The findings of our study are in agreement with the data found in the literature, attributing greater satisfaction with physical, mental and social wellbeing, as well as with elements having repercussion on sexual wellbeing, to autologous breast reconstruction. CONCLUSIONS: Autologous breast reconstruction leads to higher patient satisfaction than implant breast reconstruction. This study may help patients and medical teams in their decision-making process regarding breast reconstruction. This pilot study opens several questions that need further investigations in a larger prospective studyKeywords: Breast reconstruction, breast-Q, satisfaction, implant, autologous tissue.

Use of piezoelectric bone scalpel in hand and reconstructive microsurgery.

Performing osteotomies with piezoelectric bone scalpel is also possible with bones of larger diameter/thickness. At the same time, adjacent soft tissues are not in danger from cutting or thermal damage, reducing the risk of damaging neurovascular structures - which is of primary importance in hand and reconstructive microsurgery. These features contribute to the safety and easy execution of the procedure. The resulting bony cut is precise and permits immediate and safe bone fixation. Osteotomy of bones of >1 cm thickness takes 20-30% longer than when using a conventional oscillating saw, though the increased safety of the procedure more than compensates for this. Three cases are presented, illustrating of the use of Genera Ultrasonic for cutting bones of major thickness (metacarpal, fibula and rib) without any complication. Because of its selectivity for bony tissue, precision and ability to protect soft tissues we also advocate the use of the Genera piezoelectric bone scalpel in hand and reconstructive microsurgery.